News of a second Ebola case in the United States, representing the second transmission outside Africa after a Spanish nursing assistant contracted the virus, has quickly prompted comparisons between the way Spain and the US have dealt with the situation.
Spanish Prime Minister Mariano Rajoy, who on Friday visited the hospital where Teresa Romero is being treated, has defended his government’s management of the health crisis, pointing out that mistakes have been made in the US as well.
The fact that the Spanish nurse was the first person to contract Ebola outside Africa, and the conclusions to be drawn from that case, may also have influenced the subsequent application of health protocols in the US, where a nurse in Texas has become ill after treating a man who caught Ebola in Liberia.
Spanish experts who have been in touch with the World Health Organization (WHO) and the US Centers for Disease Control (CDC) since the beginning of the “Ebola crisis” hold that the current protocol for considering a person at risk of having Ebola – a fever of more than 38.6º – is not sensitive enough.
1. Protocol activation
The nurse who has just been diagnosed took her temperature twice a day, like all other health workers who came into contact with the country’s first Ebola patient. She called the hospital on Friday night, warning that she was running a “low fever.” Ninety minutes elapsed between that call and her admission into an isolated unit at Texas Health Presbyterian Hospital in Dallas.
Information regarding Teresa Romero’s activity on the days prior to her admission into Carlos III is still confusing and hard to come by. On September 30 she called the hospital’s occupational hazard department warning about a low fever, but was not told to seek medical assistance or even to stay home. According to several sources, this department talked to her again on October 2 but nothing happened. Early on October 6 she phoned the emergency number 112, but because her fever was still below 38.6º no protocols were activated. Romero was taken by ambulance to her nearest hospital in Alcorcón, where she spent nearly an entire day before being transferred to Carlos III.
2. Transfer and isolation
The nurse drove herself to the hospital. After preliminary blood tests came out positive on Saturday night, a specialized hazmat team decontaminated and isolated her vehicle hours later. These experts also disinfected all the parking areas that the sick woman may have touched on her way into the building.
In the early hours of October 6, a 112 physician and a medical assistant showed up at Ramos’ house, where she informed them of her job and situation. But orders were to take her to Alcorcón hospital’s emergency room, where a doctor named Juan Manuel Parra treated her for 16 hours almost all by himself, wearing a protective suit that left part of his arms exposed. He found out through the media that Romero had tested positive for Ebola. It was hours before a special ambulance came to collect her from Alcorcón hospital, which is not equipped to deal with Ebola cases.
3. Disinfection of the patient’s home
On Saturday night a specialized team of Dallas firefighters cleaned and decontaminated all the open areas in the apartment complex where the nurse lives. Police were deployed in the area as well.
The building where Romero lives was decontaminated on Thursday night and early Friday morning. Residents say this was very late, and asked why shared areas such as the elevator were not being cleaned. Romero’s apartment was disinfected on Wednesday, two days after the nursing assistant was taken to Alcorcón hospital with symptoms of Ebola.
4. ID of contacts
When a man who had been to Liberia developed Ebola in Dallas, the CDC sent a team of 90 specialists to the city, including dozens of detectives, with the mission to track down all possible contacts he may have had in recent days. After the second case emerged in a person who was not part of the group under surveillance, the CDC sent even more personnel to Dallas.
The Madrid health department conducted epidemiological surveys by telephone and door-to-door among the health workers who treated her, relatives and people that she had contact with, including two beauticians at a hair salon. How long it took to draw up the list and issue instructions is not known.
5. Monitoring of contacts
Around 48 people are being monitored at home over the first case of Ebola, following CDC protocols. None of them have shown any symptoms to date. The new patient was not part of this group. All personnel who cared for the first patient are considered to have been exposed to Ebola.
The criteria has changed over time. Ar first, people were told to take their own temperature twice a day and try to remain at home. But professionals such as the doctor who treated Romero at Alcorcón hospital insisted that people should be allowed to go to Carlos III for voluntary isolation. Fifteen individuals have decided to take this option. So far none of them have shown any symptoms of the disease.
Authorities say that they “knocked on every door on that block” to explain about the situation and the measures being taken, so that residents would not be alarmed.
Residents of the block where Teresa Romero and her husband – who is also under observation at the hospital – own an apartment have been growing angrier by the hour over what they feel is a lack of information. Many of them found out about the situation on television, despite the fact that the mayor of Alcorcón was at the hospital for five hours while the nursing assistant remained in observation there. Alcorcón authorities have since said that the home has been walled up with plasterboard for safety.
7. The dog
Dallas authorities said they believe there is a pet inside the nurse’s apartment and that it is showing no signs of infection. Mayor Mike Rawlings said there is an action plan, although no details have emerged yet.
The public found out that Romero and her husband had a dog named Excalibur when he started an online campaign to save his pet, after he was informed by Madrid authorities that they wanted to put him down for safety reasons. After hours of uncertainty and protests outside the couple’s door, the regional government went ahead with the euthanasia.
8. Informing the media
No more than 12 hours elapsed between the first positive tests and the first press conferences. In Dallas, the mayor, a county judge and a hospital representative spoke with the media, as did CDC director Thomas Frieden in Atlanta.
For days there was no designated spokesperson and health authorities failed to deny all the phony stories and hoaxes that soon began spreading online. When Health Minister Ana Mato first appeared before the press, she failed to convey a sense of calm or of being on top of the situation. Deputy Premier Soraya Sáenz de Santamaría finally took over on Friday, and since then releases have been issued periodically, with health experts taking questions from reporters.